New and Updated Reimbursement Policies – March 2026
Mon, Mar 30, 2026
Highmark regularly issues new or updated reimbursement policies. Keep an eye on the Communications Hub of the Provider Resource Center (PRC) for announcements regarding upcoming policy changes. As specific policy changes go into effect, the updated policies can be found on the Reimbursement Policies page of the PRC.
Below is a list of recent and upcoming updates to reimbursement policies (RPs):
Recently Updated
- wpa/ nepa
- cpa/ sepa
- de
- wny
- neny
March 2, 2026
RP-068 Mid-Level Practitioners and Advanced Practice Providers
This policy was updated to include the certified registered nurse anesthetist (CRNA) specialty, which will be reimbursed at 85% of the fee schedule allowance for Commercial, effective March 2, 2026.
March 27, 2026
RP-065 Modifier Reduction Glossary
This policy is no longer in use and was archived, effective March 27, 2026.
March 30, 2026
- wpa/ nepa
- cpa/ sepa
- de
- wv
RP-004 Modifiers 52 and 53
This policy was made applicable to Medicare Advantage.
RP-037 Emergency Evaluation and Management Coding Guidelines
This policy was made applicable to Delaware, Pennsylvania, and West Virginia professional claims, which will be reviewed by Highmark when submitted for emergency department services, effective March 30, 2026. For more information, CLICK HERE. (NOTE: This policy update was previously communicated as having a Feb. 2, 2026, effective date. That effective date was pushed back to March 30, 2026.)
RP-083 Spravato® (esketamine)
This policy was updated to remove code J3490 and reference to Medicare Advantage Medical Policy I-270.
Upcoming
April 6, 2026
RP-053 Advanced Gene and Cellular Therapies
Gene therapies Itvisma and Waskyra will be added.
April 27, 2026
RP-009 Modifiers 25, 59, XE, XP, XS, XU, and FT
The After-Hours Codes section will be removed from this policy, as those codes and direction will be moved to RP-041 Services Not Separately Reimbursed.
RP-033 Anesthesia Services
Direction for physical status modifiers will be removed.
- wny
- neny
RP-037 Emergency Evaluation and Management Coding Guidelines
This policy will be made applicable to New York professional claims, which will be reviewed by Highmark when submitted for emergency department services, effective April 27, 2026. For more information, CLICK HERE. (NOTE: This policy update was previously communicated as having a Feb. 2, 2026, effective date. That effective date has been pushed back to April 27, 2026.)
RP-041 Services Not Separately Reimbursed
Codes 99050, 99051, 99053, 99056, 99058, 99060, 99288, 96041, 99485, 99486, and G2211 will be added. Codes 92921, 92925, 92929, 92934, and 92938 will be removed.
RP-047 Venipuncture and Lab Services
Medicare Advantage direction will be changed. (NOTE: The version of RP-047 linked above was updated on March 18, 2026, to correct a clerical error in which Medicare Advantage information was mistakenly included under a “Commercial Reimbursement Guidelines” heading – now renamed “Reimbursement Guidelines.”)
June 29, 2026
RP-011 Procedure Codes Not Applicable to Commercial Products
This policy will be made applicable to facility providers, effective June 29, 2026.
July 1, 2026
RP-003 Convenience Kits, Drug and Biological Wastage
The Centers for Medicare and Medicaid Services (CMS) began reimbursing non-BLA (Biologics License Application) skin substitutes as incident-to supplies at a flat national rate, effective Jan. 1, 2026. Highmark is adopting the CMS flat national rate pricing methodology for non-BLA skin substitutes – with the change taking effect July 1, 2026, for Commercial plans and retroactive to Jan. 1, 2026, for Medicare Advantage plans. For more information, CLICK HERE.
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